Patient Forms

Below is a list of downloadable PDF forms. Feel free to fill out any of the forms before your appointment.

Telemedicine Forms

Please complete the forms electronically and email them to


New York State mandates physical examinations for students entering the following grades:

Sports, summer camps, and other activities usually require annual physicals. We will complete a physical form for you at the time of your child’s annual physical exam and ask that you keep a copy for your future needs.
A look at one of our exam rooms

Have a Question? Feel free to contact us.

Phone: (585) 223-6111
Fax: (585) 223-0878

New to the area & looking for a pediatrician?

We know parents like to meet the pediatrician before committing to an office and we are happy to schedule a meet-the-doctor appointment so you have that opportunity and the ability to briefly discuss any concerns you may have.

Fairport Pediatrics, LLP

460 CrossKeys Office Park
Fairport, NY 14450

Fairport Pediatrics Address

Fairport Pediatrics, LLP
460 CrossKeys Office Park
Fairport, NY 14450-3590

Connect With Us

Phone: (585) 223-6111
Fax: (585) 223-0878

Office Hours

Monday - Friday: 8 am - 4:30 pm
Saturday: 8 am - 11:30 am
Extended hours Sunday: 9:30am – 11:30am

Proudly serving patients from Monroe, Wayne and Ontario Counties.